Melda Deliana

Valproate use and thyroid dysfunction in children with idiopathic epilepsy

Corresponding author: Josephine J. Sibarani, MD. Department of Child Health, Universitas Sumatera Utara Medical School/H. Adam Malik Hospital,Jl. Bunga Lau No.17 Medan, 20136, North Sumatera, Indonesia. Phone/Fax. +62-61-8361721; Email: sibaraniNyjosephine@gmail.com. Abstract Background Long-term administration of valproic acid (VPA) has side effects, including thyroid dysfunction. Subclinical hypothyroidism (SCH) identified by elevated serum thyroid stimulating hormone (TSH) concentrations with normal thyroxine (T4) and triiodothyronine (T3), or normal free thyroxine (fT4) and free triiodothyronine (fT3) has been demonstrated in idiopathic epilepsy patients receiving VPA. Objective To evaluate for associations between age at initiation of VPA treatment and duration of treatment with thyroid dysfunction. Methods A cross-sectional study was conducted from October 2012 to May 2013 in Haji Adam Malik and Pirngadi Hospitals, Medan, North Sumatera. Subjects were children ranging from 0 and below 18 years who had been diagnosed with idiopathic epilepsy. Blood specimens were taken to evaluate serum T3, T4, and TSH levels in all subjects. Data were analyzed using bivariate and multivariate analyses. Results A total of 49 subjects were included in the study. Age of ≤ 4 years at initiation of VPA was found to be a significant risk factor for SCH in the bivariate analysis (OR 6.67; 95%CI 1.215 to 36.594, P=0.036). Three factors had P values <0.25 in the bivariate analysis and were subsequently analyzed by stepwise multivariate regression test: age at initiation of VPA, duration of treatment, and drug dosage. The VPA initiation at age <4 years had 6.67 times the risk of SCH than the age of >4 years (95%CI 1.215 to 36.594; P=0.029). Duration of treatment and VPA dosage were not significantly associated with SCH on multivariate analysis Conclusion Age ≤ 4 years old at the initiation of VPA is associated with thyroid dysfunction. However, no significant association was found between duration of treatment as well as drug dosage with thyroid dysfunction. [Paediatr Indones. 2018;58:192-7; doi: http://dx.doi.org/10.14238/ pi58.4.2018.192-7 ].

The Effect of Psychological Stress on Salivary Testosterone in Puberty Children

BACKGROUND: Psychological stress is a condition that is experienced by many adolescents which affect the Hypothalamic-Pituitary-Gonadal axis. Testosterone is known as a sex steroid hormone that is susceptible to acute stress and can be measured through saliva. Disruption of the reproductive system can affect the sexual maturation process. AIM: To understand the difference in salivary testosterone levels in puberty children before and after given a stressor. METHODS: A quasi-experimental intervention study was conducted at Antonius Bangun Mulia junior high school, Medan, North Sumatera, in July-October 2017. Subjects were students aged 12-14 years with sexual maturity G2 for boys and M2 for girls. Psychological stress intervention was generated by the Wechsler intelligence scale for children fourth edition (WISC IV). Saliva was collected before and after the intervention. The analysis was done with Wilcoxon test and a P value < 0.05 was considered significant. RESULTS: Forty-two subjects of 24 male students and 18 female students with sexual maturation Tanner II (54.8%) and Tanner III (45.2%). This study obtained that there was a statistically significant difference in salivary testosterone levels before and after the subject was given a stressor (P = 0.015, CI 95%). This difference also was seen within sexual maturation Tanner II (P = 0.045, CI 95%). No difference was observed in testosterone levels based on gender, male students (P = 0.065, CI 95%) and female students (P = 0.112, CI 95%). CONCLUSION: Stress can affect salivary testosterone levels. There was a statistically significant difference in salivary testosterone levels before and after psychological stress in puberty children.

Relationship between age at menarche and exposure to sexual content in audio-visual media and other factors in Islamic junior high school girls

Background In recent decades, girls have experienced menarche at earlier ages, which may have negative effects on health. Exposure to audio-visual media and other factors may influence the age at menarche, although past studies have produced inconsistent results. Objective To assess for relationships between the age at menarche and audio-visual media exposure, socio-economic status, nutritional status, physical activity, and psychosocial dysfunction in adolescent girls. Methods This cross-sectional study was conducted from August to October 2015 in students from two integrated Islamic junior high schools in Medan, North Sumatera. There were 216 students who met the inclusion criteria: aged 10-16 years and experienced menarche. They were asked to fill out questionnaires that had been previously validated, regarding their history of exposure to audio-visual media, physical activity, and psychosocial dysfunction. The data were analyzed by Chi-square and Fisher’s exact tests in order to assess for relationships between audio-visual media exposure and other potential factors with the age at menarche. Results Of 261 female students at the two schools, 216 had undergone menarche, with a mean age at menarche of 11.6 (SD 1.13) years. There was no significant relationship between age at menarche and audio-visual media exposure (P=0.68). Also, there were no significant relationships between factors such as socio-economic and psychosocial status with age at menarche (P=0.64 and P=0.28, respectively). However, there were significant relationships between earlier age at menarche and overweight/obese nutritional status (P=0.02) as well as low physical activity (P=0.01). Multivariate logistic regression analysis showed that low physical activity had the strongest influence on early menarche (RP=2.40; 95%CI 0.92 to 6.24). Conclusion Age at menarche is not significantly associated with sexual content of audio-visual media exposure. However, there were significant relationships between earlier age at menarche and obese/overweight nutritional status as well as low physical activity.

Prevalensi Mikropenis pada Murid Taman Kanak - Kanak

Penis kecil yang sering dikeluhkan orang tua pada umumnya mengenai ukuran panjangnya. Sebenarnya selain dimensi panjang penis, diameter maupun konsistensi penis perlu diperhatikan juga apakah normal atau tidak. Penelitian ini bertujuan untuk mengetahui ukuran penis anak usia 2-6 tahun di Kelompok Bermain dan Taman Kanakkanak. Penelitian ini merupakan studi deskriptif. Data penelitian diperoleh dari kunjungan pada empat Taman Kanak-kanak (TK) di Kota Madya Medan yaitu TK Harapan, TK Al-Azhar, TK Al-Ikhsan, dan TK Yayasan Pendidikan Shafiyyatul Amaliyyah (YPSA) pada tanggal 16–19 Oktober 2004. Responden pada penelitian ini berjumlah 107 anak berusia 2- 6 tahun. Diagnosis mikropenis ditegakkan bila ukuran panjang penis kurang dari -2,5 SD untuk usia tanpa disertai kelainan anatomis penis sedangkan small penis adalah bila ukuran panjang penis berada di antara nilai rerata dan -2,5 SD. Dijumpai 9 anak dengan gizi lebih (>NCHS), 2 anak obesitas (IMT>P95) , 7 anak gizi baik (P3- NCHS) dan 91 anak gizi kurang ( NCHS), 3 anak perawakan pendek (<NCHS), dan 102 anak perawakan normal (P3- NCHS). Pada penelitian ini ditemui 20 kasus mikropenis (18,7%), small penis ditemukan 77 kasus (72%) sedangkan yang memiliki ukuran penis normal 10 orang (9,4%).

Gambaran Kunjungan Pasien Rawat Jalan Endokrinologi Anak dan Remaja FK USU / RS. H. Adam Malik Medan, Tahun 2000-2004

Latar belakang. Masyarakat banyak yang tidak mengetahui bahwa kelainan endokrin pada anak membutuhkan penanganan yang khusus dari ahli endokrinologi anak. Tujuan penelitian. Penelitian ini bertujuan untuk mengetahui gambaran kunjungan pasien endokrinologi anak dan remaja di RS H.Adam Malik Medan tahun 2000-2004. Metoda. Penelitian ini merupakan studi deskriptif retrospektif. Data diperoleh dari catatan rekam medik pasien yang berkunjung ke Poliklinik Endokrinologi Anak dan Remaja FKUSU/RS. H. Adam Malik Medan dalam kurun waktu Januari 2000-Desember 2004. Hasil. Terdapat 93 pasien yang berkunjung ke Poliklinik Endokrinologi Anak dan Remaja, 33 anak perempuan (35%) dan 60 anak laki-laki(65%). Sebaran umur pada saat datang pertama kali adalah 33 anak (35%) berusia 0-5 tahun, 25 anak (27%) berusia > 5-10 tahun, 25 anak (27) % > 10-15 tahun, dan 10 anak (11%) berusia >15 tahun. Keluhan utama yang paling sering muncul pada saat pasien datang berobat pertama kali adalah alat kelamin laki-laki kecil 15 kasus (16%) dan buah zakar tidak turun 15 kasus (16%), keluhan anak pendek 13 kasus (14%), benjolan di leher 12 kasus (13 %). Diagnosis yang dijumpai adalah kriptorkismus (20%), mikropenis (16%) dan hipotiroidisme kongenital (13%). Status gizi berdasarkan NCHS WHO 2000 pada pasien yang berkunjung terutama gizi baik, terdapat pada 22 kasus (23,6%). Kesimpulan. Kasus terbanyak berkunjung ke Poliklinik Endokrinologi Anak dan Remaja adalah kriptorkismus (20%), mikropenis (16%) dan hipotiroidisme kongenital (13%). Diduga masih banyak kasus endokrinologi anak dan remaja yang tidak ditangani oleh ahli endokrinologi anak secara komprehensif oleh karena kemungkinan banyak kasus yang tidak dirujuk.

Tata Laksana Kejang Demam pada Anak

Kejang demam adalah bangkitan kejang yang terjadi pada kenaikan suhu tubuh (suhu rektal lebih dari, 38oC) akibat suatu proses ekstra kranial, biasanya terjadi antara umur 3 bulan dan 5 tahun. Setiap kejang kemungkinan dapat menimbulkan epilepsi dan trauma pada otak, sehingga mencemaskan orang tua. Pengobatan dengan antikonvulsan setiap hari yaitu dengan fenobarbital atau asam valproat mengurangi kejadian kejang demam berulang. Obat pencegahan kejang tanpa demam (epilepsi) tidak pernah dilaporkan. Pengobatan intermittent dengan diazepam pada permulaan pada kejang demam pertama memberikan hasil yang lebih baik. Antipiretik bermanfaat, tetapi tidak dapat mencegah kejang demam namun tidak dapat mencegah berulangnya kejang demam.